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FOR OFFICE USE: <br /> ............. APPLICATION..,_..._...._..._.........------------- FOR SANITATION PERMITPermit No. ..7�...1 <br /> 1CompWo in Tr(plicafe) '.. .. <br /> -- . . . ... �..:...,.._. _. _ <br /> This Permit Expires I Year From Dole Issued -Date Issued <br /> Application is hereby made to the San Joaquin Loco! Health District for a permit to construct and install the work herein <br /> described. This application Is made in compliance with County Ordinance No. 549:and existing Rules and Regulations: <br /> JOB AI7DR1:5S/LOCATION .. _ 3.._. ......... ....... - d ............CENSUS TRACT .......................... <br /> A ]}l y.._ <br /> Owner's Name .......... ..Z... -t-�t...... . .. . ....... ................................. ..,.�:}:............... <br /> .Phone <br /> Address -1.............l.. Sj7• . ...City ...R ........_.__................... .......... <br /> Contractor's Name ................ . ...... ........ ----- -•-- ... . .... -:.....................License 0 s .3�3.... Phone ..Ar 7...... <br /> 3 <br /> Installation will serve: Residence Apartment House f3 Commercial❑Trailer Court ❑ <br /> Motel ❑Other............................................ <br /> Number of living units:...... ..... Number of bedrooms ..�7......Garbage Grinder ............ Lot Size ... Q...�-�. L-4...r............ <br /> Water Supply: Public System and name ............................................... ._._........s�...................................................PrivateA <br /> Character of sail to a depth of 3 feet; Sand r] Silt Q Clay 0\ Peat <br /> ❑ Sandy Loath❑ Clay Loam ❑ <br /> Hordpon f g Adobe 'Fill Waterial ............ If yes,type............... ............ <br /> j <br /> (Piot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be plated on reverse side.) <br /> NEW INSTALLATION; (Na septic tank or seepage.pit permitted if public sewer is available within 2Q0 feet,I <br /> PACKAGE TREATMENT } SEPTIC TANK{ ) •Sise`:.............:............................ Liquid Depth .......................... <br /> Capacity .................... Type ...I................ Materlol.........------....... No. Compartments ....................... <br /> . Distance to nearest: Well .Foundation .. ...... Prop..Line............... ... .r l <br /> N <br /> LEACHING UNE,, f ) No. of lines ........................ Length of eachline............................ Total Length ............................ N <br /> Box ....... _... Type Filter Material ....................Depth Filter Material ...... <br /> _:- y. . <br /> Distance to nearest: Well ........................ Foundation ........................ Property Una ......................... r <br /> SEEPAGE PET ( J Depth .................... Diameter._:'......... ..:.. Number ............................ Rock Filled Yes ❑ No ❑ . <br /> Water Table Depth •-------- ---------......---•-----M-...........Rock Size •-- .................... <br /> . <br /> -Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... 0 <br /> REPAIR/.ADDITION(Prev. Sanitation Permit# ........ ................................... Date ...................................} <br /> Septic Tank (Specify Requirements). --------_-�--.-...._. .................:..................................'.................:.....:............----..._.............. <br /> Disposal Field (Specify Requirements) --- -----7.0.._... Q� .... .............................................................. <br /> ._..... ._....I------------------------ <br /> `� ... , .`...._ -rte .. ..: .-•................................•-•- <br /> ------------------•--.....------------------.----•---------------.---..... -•-- ---- ........................... <br /> (Draw existing and required addition on reverse side) 7 <br /> 1 hereby certify that i have prepared this application and that the work will be done in Accordance with Son Jeaqu <br /> County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed __...._---- ------ - ----- Owner <br /> BYr. . -•---•---------------- Title _..... •_..... <br /> (If of er n owner] <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY-----c...,.--- - -- . • • -----------------•----......--•-----•---. . DATE ...�..- .�-_3 % ...---------:-- = <br /> BUILDING PERMIT ISSUED -.. - -------- - ------- ....DATE _.._ <br /> .................. ................................. <br /> ADDITIONAL_ COMMENTS ------------------------ -- _...._...._.. :......::._.. <br /> ----------•-•--------------_-----_-- ------------------- ...........................-....................................... <br /> _------------------------- <br /> .--•...... ........ - ---- <br /> fina# Inspection by: '.. --- ---------- - -- ------------------------------------------------------------------ <br /> ...._Date .- Y .-y_. .. <br /> EH 13 .2'h 1-68 Rev. 5M JAN­JOAQU-11-N LOCAL HEALTH DISTRICT 8/74 3M <br />